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Emily Newman tends to her 2-year-old twins, Rory and Everett, at their Seattle home. Newman was able to get the toddlers a first dose of swine flu vaccine, but fears she won't find a necessary second dose. That's especially troubling because Rory has Type 1 diabetes, which puts her at higher risk for infection.

But Newman’s relief over protecting her daughter, Rory, and son, Everett, against H1N1 influenza infection was short-lived. She soon realized she had a second worry: What about the booster?

Government health officials say that children younger than 10 need two doses of the vaccine to gain immunity from the pandemic virus that has killed some 4,000 people in the United States since April, including 540 kids.

But a shortage of vaccine has meant fewer than 42 million doses have been delivered nationwide out of at least 120 million expected by now, federal health officials report. A manufacturing delay has sparked long lines, shuttered many flu clinics and sent an ominous message to parents seeking a second round of H1N1 shots: Don't count on it.

“We have found virtually no one to assure us that we will find a booster shot soon,” said Newman, who is especially worried about Rory, who has Type 1 diabetes and was hospitalized with a suspected H1N1 infection a week after her first vaccine. “The system seems to be failing in multiple ways.”

Parents’ concerns are valid, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. He oversaw the clinical trials of swine flu vaccine in adults and children and says latest results indicate that young kids need two doses about a month apart for complete immunity.

After a single dose of vaccine, only 55 percent of children ages 3 to 9 developed enough immune response within 21 days to protect them fully against the H1N1 flu. After a second dose, 94 percent were protected, Fauci said.

Among the youngest children, those ages 6 months to 35 months, only 25 percent posted a strong enough response after just one dose.

Until the vaccine shortage is resolved, however, parents should know that even a single shot confers some protection that may at least lessen the infection’s severity, Fauci said. And if a second dose is delayed a month — or even longer — that’s fine.

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Officials with the federal Centers for Disease Control and Prevention advise that doctors and clinics should provide booster doses to kids younger than 10, even when other high-risk patients haven’t received a first shot.

“The bottom line is, a provider should not be deferring a second dose,” CDC spokesman Tom Skinner wrote in an e-mail.

Even so, some clinics nationwide have said they’ll delay second shots. At the Park Nicollet health system in St. Louis Park, Minn., hospital officials say they won’t reserve second doses for children who’d already received one shot.

“We have 9,000 high-risk people who have not received their first shot, so we’re making sure they receive that, and then we’re circling back,” said Jeremiah Whitten, a hospital system spokesman.

He said they were basing that decision on a CDC report last summer that told providers not to hold doses in reserve.

Not enough to go around
Other doctors and clinics are simply warning patients that there likely won’t be enough to go around. That’s the message Kristen Cunningham, 33, of Allentown, Pa., got when she found a first shot for her 2-year-old son, Jake.

“The doctor said, ‘Just so you know, he’s probably not going to get the second one, because we don’t know whether we’re getting it in,’” Cunningham said.

That uncertainty is frustrating to parents who had to go to extreme lengths to acquire the vaccine for their kids. Maigan Vanditto, 32, of Coeur d’Alene, Idaho, said she stood outside in chilly weather for nearly an hour with her daughters, Lizzy, 5, and Allie, 2, to get swine flu shots at a local health clinic.

“I am grateful that the kids have shot No. 1, but they were very clear when we were leaving that we were not guaranteed a place at the next clinic in 28 days for the kids to get the necessary booster shot,” she said. “As it stands now, they really aren’t protected.”

But Cynthia Taggart, a spokeswoman for the Idaho health district that’s doling out the shots, said supplies of vaccine have been slow, but they’re increasing. She advised that Vanditto and others who fear it’ll be impossible to get their kids fully vaccinated shouldn’t worry.

“It is possible and they will be protected,” said Taggart of the Panhandle Health District.

Mixed message
In the Seattle county where Emily Newman lives, health officials are advising providers not to reserve vaccine for kids who’ve already had one shot. At the same time, if children who’ve had a first shot show up for a second dose, providers shouldn't turn them away, said James Apa, a spokesman for Public Health of Seattle and King county.

“It's a very mixed message,” said Newman, who added that such “passive” advice angers and scares her.

Rory was seriously ill with suspected swine flu, but the diagnosis was not confirmed and doctors say the toddler needs a booster shot to be certain she won’t come down with a potentially fatal version of the illness.

Everett, Newman’s son, should get a second shot, too, but he’s a healthy boy and not nearly as at-risk as his sister, she says.

That distinction is at the core of Newman’s frustration with the way swine flu shots have been distributed in Seattle and across the nation. She believes there should be more emphasis — and more enforcement — to ensure that priority groups are actually getting access to the limited supplies of vaccine.

“They’re not accepting at all that there are certain individuals who need that second shot more,” she said. “If you fall into multiple risk categories, you should be at the top of the list.”

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GlaxoSmithKline's Pandemrix swine flu vaccine has been linked to cases of the rare sleep disorder narcolepsy in children in a scientific study in England that confirms similar findings elsewhere in Europe.